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1057 SEDEEVA STU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1 -9. OMB No. 1660 -0008 Expiration Date: November 30, 2018 Copt/ all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name MOLLY POWER Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Company NAIC Number: City State ZIP Code CLEARWATER Florida 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 15, BLOCK B OF FLORIDENA CLEARWATER BAY A4. Building Use (e.g., A5. Latitude /Longitude: A6. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non - Residential, Addition, Lat. 27.992202 Long. - 82.793006 Accessory, etc.) RESIDENTIAL Horizontal Datum: obtain flood insurance. 1.0 foot above above adjacent • adjacent grade NAD 1927 grade p NAD 1983 14 2 photographs of the building if the Certificate Number 8 is being used to 1,421 sq ft a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b 1,456 sq or enclosure(s) within in ft within 1.0 foot sq in 0 sq • Yes © No garage: garage 0 openings in the attached garage in A9.b 0 • Yes © No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map /Panel Number 12103C0106 B5. Suffix H B6. FIRM Index Date 05/17/2005 B7. FIRM Panel Effective/ Revised Date 05/17/2005 B8. Flood Zone(s) X & AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources data or base flood depth entered in Item B9: x FIRM datum used located in a ❑ NGVD System • Other /Source: 1988 ❑ Other /Source: or Otherwise Protected Area (OPA)? 1929 x NAVD (CBRS) area ❑ OPA • Yes p No • CBRS FEMA Form 086 -0 -33 (7/15) 1057 SEDEEVA ST BCP2017 -10073 REMODEL POWER, MOLLY THE Zoning: Low Medium Density Atlas #: 251A Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: November 30, 201 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Policy Number: City State ZIP Code CLEARWATER Florida 33755 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: • Construction Drawings* • Building Under Construction* x Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 —V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 —A30, AR/AH, AR/AO. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: AG 0047 Vertical Datum: NAVD'88 Indicate elevation datum used for the elevations IN NGVD 1929 IN NAVD 1988 • in items a) through h) below. Other /Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 11, 35 x feet ❑ meters b) Top of the next higher floor 13 93 p feet • meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A x p x p x feet ❑ meters feet ❑ meters d) Attached garage (top of slab) N/A e) Lowest elevation of machinery or equipment servicing the building 11 99 feet III meters feet • meters feet • meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 11, 11 g) Highest adjacent (finished) grade next to building (HAG) 11. 35 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. p feet • meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. t understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? • Yes • No • Check here if attachments. Certifier's Name License Number ALAN E. ROZON, JR. 6513 � r'.. rt0ec� uses vt;H�'' 6513 *, S I ATE OF s FLORIDA k5, Title PSM # 6513 Company Name FIRST CHOICE SURVEYING, INC. Address PO BOX 470978 City State ZIP Code LAKE MONROE Florida 32747 suR lz..'t Signature Date Telephone Alan E. Rozon Dgtallye oe,by Alan E Rom" 06122!2016 (407) 951 -3425 Date: 201608 22 13 33 09 -06'00' Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) MACHINERY = A/C PAD; SURVEYOR MAKES NO GUARANTEES TO THE ACTUAL SIZE OF THE GARAGE, MEASUREMENTS TAKEN FROM THE OUTSIDE. FCS # 20475 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 • IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Policy Number: City State ZIP Code CLEARWATER Florida 33755 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 —E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B,and C. For Items E1 —E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is • feet • meters • above or • below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is x feet ❑ meters x above or ❑ below the LAG. E2. For Building Diagrams 6 -9 with permanent flood openings provided in Section A Items 8 and /or the next higher floor (elevation C2.b in 9 (see pages 1 -2 of Instructions), ❑ above or ❑ below the HAG. the diagrams) of the building is x feet ❑ meters E3. Attached garage (top of slab) is X feet ❑ meters x above or ■ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is © feet ❑ meters • above or • below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's this information in Section G. floodplain management ordinance? • Yes • No • Unknown. The local official must certify SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Florida Signature Date Telephone Comments • Check here if attachments. FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Policy Number: City State ZIP Code CLEARWATER Florida 33755 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8 —G10. In Puerto Rico only, enter to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA- issued or community- issued BFE) is provided for community floodplain management purposes. G1. • The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. G3. ❑ The following information (Items G4 —G10) G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance /Occupancy Issued ❑ feet G7. This permit has been issued for: • New Construction • Substantial Improvement G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: basement) • meters Datum building site: • feet ❑ feet • meters Datum • meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660 -0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Policy Number: City CLEARWATER State Florida ZIP Code 33755 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View "; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Photo One Photo One Caption 06/22/2016 FRONT Photo Two Photo Two Caption 06/22/2016 SIDE FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660 -0008 Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1057 SEDEEVA STREET Policy Number: City CLEARWATER State Florida ZIP Code 33755 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and 'Rear View "; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. Photo One Photo One Caption 06/22/2016 BACK Photo Two Photo Two Caption 06/22/2016 SIDE FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 6 of 6 Building Diagrams DIAGRAM 7 All buildings elevated on full -story foundation walls with a partially or fully enclosed area below the elevated floor. This includes walkout levels, where at least 1 side is at or above grade. The principal use of this building is located in the elevated floors of the building. Distinguishing Feature - For all zones, the area below the elevated floor is enclosed, either partially or fully. In A Zones, the partially or fully enclosed area below the elevated floor is with or without openings** present in the walls of the enclosure. Indicate information about enclosure size and openings in Section A - Property Information. DIAGRAM 8 All buildings elevated on a crawlspace with the floor of the crawlspace at or above grade on at least 1 side, with or without an attached garage. Distinguishing Feature - For all zones, the area below the first floor is enclosed by solid or partial perimeter walls. In all A zones, the crawlspace is with or without openings ** present in the walls of the crawlspace. Indicate information about crawlspace size and openings in Section A - Property Information. DIAGRAM 9 All buildings (other than split - level) elevated on a sub - grade crawlspace, with or without attached garage. Distinguishing Feature - The bottom (crawlspace) floor is below ground level (grade) on all sides.* (If the distance from the crawlspace floor to the top of the next higher floor is more than 5 feet, or the crawlspace floor is more than 2 feet below the grade [LAG] on all sides, use Diagram 2A or 2B.) A floor that is below ground level grade) on all sides is considered a basement even if the floor is used for living purposes, or as an office, garage, workshop, etc. ** An "opening" is a permanent opening that allows for the free passage of water automatically in both directions without human intervention. Under the NFIP, a minimum of 2 openings is required for enclosures or crawlspaces. The openings shall provide a total net area of not less than 1 square inch for every square foot of area enclosed, excluding any bars, louvers, or other covers of the opening. Alternatively, an Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES) must be submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls. A window, a door, or a garage door is not considered an opening; openings may be installed in doors. Openings shall be on at least 2 sides of the enclosed area. If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter. The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. For more guidance on openings, see NFIP Technical Bulletin 1. NFIP Elevation Certificate Instructions — Page 9 of 9